The Global Fund to Fight AIDS, Tuberculosis and Malaria is scheduled to announce a new round of grants in January. However, the executive director of the fund is warning of a lack of new commitments for donations. The issue has stirred debate over how much the United States – as the remaining superpower - should be contributing to the fund.

The head of the global fund, Richard Feachem, says any delay in funding “will be measured by millions of lives lost and billions of dollars in additional costs.” He urges donors not to underestimate the scope of the HIV/AIDS pandemic.

He says, "It is by far the largest catastrophe to befall human kind in recorded human history. It’s already a good deal worse than the Black Death in the middle of the fourteenth century. And on current projections the epidemic isn’t going to peak before about 2050 or 2060."

Professor Feachem says while most of the HIV/AIDS cases are currently in sub-Saharan Africa, the pandemic is poised to sweep across Asia, especially India.

He says, "The epicenter of the epidemic is moving to Asia – and that India is on an African trajectory, but just running about fifteen years behind Africa. And the scale of the Indian epidemic is going to be absolutely staggering. And at the moment there is nothing in place to attenuate or modify that Asian epidemic. HIV is surely going to kill far more Indians than any war with Pakistan could possibly kill. And yet the focus on India today is on the possibility of a war with Pakistan and not on a war against a virus."

The global fund gives priority to – what it calls – “effective proposals from countries and regions with the greatest need, based on the highest burden of disease and the least ability to bring financial resources” to bear.

Early this year (2002), the fund awarded some 600-million dollars in its first round of grants.

The second round of grants is due in January and is expected to be larger. But Professor Feachem says, despite two billion dollars in pledges, a financial shortfall is looming.

Professor Feachem, "In addition to the monies already pledged, the global fund needs an additional seven billion dollars before the end of 2004. And that’s a need not for pledges of seven billion dollars, but for seven billion dollars actually in our bank account by the end of 2004. And we are calling loudly with our partners and collaborators for those funds to be made available. Without that, the third round, which occurs in the middle of next year, will be put in serious jeopardy."

Many anti-AIDS activists say the United States – being the only remaining superpower – should do a lot more to fight HIV/AIDS. Jeffrey Sachs, director of the Earth Institute at Columbia University, is a long time critic of the Bush Administration when it comes to AIDS policy. Professor Sachs, who’s also calling for increased donations to the global fund, says the administration has no strategy to fight HIV/AIDS.

He says, "We have a strategy, I think, in this government with respect to Iraq. It seems there’s a strategy with respect to the war on terrorism. We have not yet seen a strategy with respect to the war against AIDS, malaria and tuberculosis. If there is such a strategy in the US government it’s been very well hidden I’m afraid. And it can’t afford to be hidden. We need a multi-year scenario in this country of the administration, which says how they are going to fight together with other countries through instruments like the Global Fund or the World Bank or USAID – how they are going to fight this disease at a scale that it requires."

Professor Sachs says it would be “shocking” if President Bush went on his planned trip to Africa next year and did not have such a strategy.

However, the Bush Administration rejects Professor Sachs’ criticism – and that of others - who say the United States is not doing enough to battle HIV/AIDS. It says by fiscal year 2003, total US spending to stop the pandemic will reach one-point-four billion dollars. It says that’s more than eighty percent higher than during the previous Clinton Administration.

Dr. Joe O’Neill, director of the White House Office of National AIDS Policy, says the administration “absolutely has an AIDS strategy” – and that strategy is indicated by what’s already been done.

He says, "We have started the Global AIDS Fund. We’ve made the major contributions to the fund. Since President Bush has been in office, the dollars for global HIV has increased by eighty-two percent. President Bush has announced a new clinically oriented, medically oriented, public health oriented initiative to interrupt vertical transmission, peri-natal transmission and provide care for mothers and families. That’s a piece of our strategy. In the Millennium Challenge Account, he has committed to doubling the total amount of foreign assistance over the next three fiscal years. And finally, part of the strategy was frankly to appoint a well known AIDS physician who’s very experienced in AIDS care and treatment and prevention – and who has a great track record and a long track record in administration of complex public health programs to his AIDS office."

Dr. O’Neill says the United States has contributed five hundred million dollars to the Global Fund to Fight Aids, Tuberculosis and Malaria. That’s half of all contributions and actual cash in hand, not pledges. What’s more, he says, as of October, the United States is the only country to have made a second donation to the fund.

Asked whether the Bush Administration should be doing a better public relations job regarding its AIDS campaign, Dr. O’Neill says the administration is more interested in substance.

Dr. O'Neill says, "I think one of the characteristics of this White House – and I think it takes people a while to get used to that because the public has been used to a different style – this White House is very focused on rolling up our sleeves and getting the work done. I point out to you that within not only this White House but within the US government, we have the most experienced, brightest, talented collection of HIV experts arguably – not arguably – in the world. These are the people that we’ve been consulting with in developing our action plans. But I want to point out, our first priority is first and always to get the job done and to do good work."

The head of the global fund, Richard Feachem, says he plans to lobby the Bush Administration for more money when he visits Washington in early December. He says the fund has only seven hundred million dollars on hand and is facing a “cash crunch.”